Pallor can be normal, or a sign of an underlying medical condition. Many children have a fair complexion and look pale, especially in the winter months. Most children look pale when they are unwell. Parents have the best idea of the health of their child. If your child is active, eating well, full of energy, and seems otherwise normal, it is most unlikely that his paleness indicates an underlying serious medical condition.

If, on the other hand, your child is pale and also appears tired, uninterested in eating or is otherwise unwell, you should consult your doctor. After a careful medical history and physical examination, he may order a blood test to see if your child is anaemic or has some other underlying condition.

THALASSAEMIA

Thalassaemia is an inherited disease where there is an abnormality of haemoglobin, that part of the red blood cell which carries oxygen around the body. It is seen much more frequently in certain ethnic groups, especially those from the Mediterranean countries and parts of East Asia.

In its severe form (Thalassaemia Major) the condition, if not treated, causes severe anaemia, growth retardation, and early death due to heart failure. Treatment consists of regular and frequent blood transfusions. In addition, a particular drug is given to mop up the excessive amounts of iron that are the result of the rapid destruction of the faulty red blood cells. With this treatment, children can live essentially normal lives.

There is also a mild form of thalassaemia (Thalassaemia Minor) which leads to a very mild anaemia but usually causes no symptoms at all. It is important for someone to know if they have Thalassaemia Minor: if they marry a partner with the same condition then there is a one in four chance that their children will be affected with Thalassaemia Major. Antenatal diagnosis is now available for this condition.

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Cause

The cause of leukaemia is still unknown, despite many years of intensive research all over the world.

Clinical features

The child may present with features of anaemia (pallor, fatigue), easy bruising, pain in the back or legs, or enlarged but painless lymph glands in his neck or other parts of his body. He may be generally unwell, with poor appetite and overall lethargy.

Investigations

A blood test is performed initially, and this establishes the diagnosis, but then a bone marrow aspiration always follows to confirm it. Often other tests are necessary, including X-rays and CT scans.

Treatment

The child is admitted to hospital immediately — this is invariably to one of the major paediatric teaching hospitals. Treatment is highly specialised and the exact regime depends on the type of leukaemia. It includes drugs to kill the leukaemia cells (chemotherapy), as well as other drugs and blood transfusions. Close follow-up is important and takes place according to a carefully designed protocol or plan.

When to see your doctor

Even if your child has any of the symptoms described above, it is unlikely that he has leukaemia. There are many more common and less serious causes of all of these symptoms. Nevertheless, you should consult your doctor if you are worried. He may order a simple blood test to put your mind at ease.

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Toddlers and school age children forever seem to have bruises, especially on the shins, as a result of their everyday activities. Their high energy levels and ceaseless activity mean that they often bump into things or fall over, thus bruising various parts of their body. Children with poor co-ordination may have more than their fair share of bruises. Bruises are usually just a normal part of childhood and are no cause for concern.

In very rare cases, bruising is due to an underlying blood disorder, such as a deficiency in the clotting mechanism. You may want to see a doctor if your child seems to bruise more readily than other children, or has bruises all over his body, or if you have a family history of blood disorders.

HAEMOPHILIA

This is an inherited bleeding disorder seen almost exclusively in boys. It is due to a deficiency of one of the substances in the blood (Factor VIII) which is essential for the clotting process. Boys affected with the condition usually present at an early age with bleeding (for example, recurrent nosebleeds which are difficult to stop) or easy and extensive bruising after seemingly trivial injuries.

Treatment of this condition is usually in a specialised unit. It involves the administration of Factor VIII after bleeding episodes. A child with haemophilia always needs to avoid contact sports.

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When to see your doctor

• if you suspect that your child may be anaemic because he is very pale;

• if your child is irritable yet lethargic and drinks large volumes of milk at the expense of solids;

• if you want additional information about what to feed your baby.

Prevention

Iron deficiency anaemia can mostly be prevented by making sure that your child has a balanced diet after the age of 6 months. Most health professionals now advise against giving babies cow’s milk earlier than 12 months of age. Your local maternal and child health nurse or doctor can give you specific information about nutritional intake.

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Parents like to follow the course of the child’s development, and to record the occasions when their child achieves certain milestones. You can record these dates and ages in the space provided in the table below.

Parents are often the first to detect signs of developmental delay, when the child is late in achieving milestones. The table below lists a number of developmental milestones and the average or range of ages at which most children achieve them. Remember that this is a guide only, and there is considerable variation in development between children. A child’s development is a dynamic process. You should not be alarmed if your child is slower in achieving these milestones. Equally, fast development may not indicate that your child is unusually gifted. However, if your child is consistently and significantly delayed in the age at which he reaches these milestones, then you should consult your doctor or maternal and child health nurse. He or she will check your child’s development, and refer him to a specialist if necessary. Parents usually know intuitively whether their child is doing well devel-opmentally or not. Do not hesitate to seek reassurance if you are at all concerned.

Remember that these ages are average ages, and that there are children who are faster and children who are slower developers. Just because your child is later in achieving milestones than outlined in the table above, it does not mean that he is developing abnormally. However, if he is later in a number of milestones and you are at all concerned, or if you are worried about your child’s hearing or language development at any age you should not hesitate to consult your doctor or maternal and child health nurse.

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In the case of the painkillers on the list other than aspirin and paracetamol, if you take the same one regularly for some weeks, you are likely to find it is not working as well, or for as long. This is normal and expected. It does not mean that you are getting addicted to your painkiller. What happens is that your body develops ways of getting rid of the drug more quickly. It now takes more of the painkiller to achieve the same amount in your blood. Therefore, when you find that the dose which used to control your pain no longer does so, it is quite safe, and indeed necessary, to increase your dose. The higher dose is no more dangerous and will cause no more side effects for you than the usual starting dose would for someone who had not been taking painkillers.

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A lack of Vitamin B12, because of degeneration of these special cells of the stomach, which produce the intrinsic factor, is the cause of pernicious anaemia.

This disease, called pernicious when it was first discovered because the anaemia does not respond to the intake of iron, is treated by giving Â12 by injection.

As a final summary, let me say that vitamins are essential to good health.

A normal balanced diet contains all these essential food factors. And therefore, the taking of extra vitamins does no good whatever.

However, in certain disease states where there is a poor absorption of foodstuffs, or where an inadequate intake occurs, such as with the poor, the elderly, the unprivileged, the artificially fed infant or the food faddists, supplements of vitamins may be necessary.

For the rest of us they are not of much use. They will not necessarily do what you expect them to do.

But if you avoid taking an excessive quantity of them, you probably will do yourself no harm.

I suppose that if you believe that something will do you good, then it just might be of benefit.

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The foot has 26 bones, 19 muscles, 33 joints and over 100 ligaments.

It is a complex, strong, supple structure which supports us through life, yet we squeeze it into shoes which are too tight and designed by the whim of fashion rather than for comfort.

Management of problems of the feet mainly rests with the medical profession.

The general practitioner sees and deals with most problems, referring the more difficult, or those which require operation, to an orthopaedic surgeon.

In the past, chiropodists confined their practice to cutting toenails and paring corns and calluses.

They have now changed their name to podiatrists and have more training in all aspects of feet problems. Increasingly, people are going directly to podiatrists when feet start to ache.

Let us look at a few of the common foot problems.

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